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Welcoming an Infant Home Can Be Overwhelming!

If you’re a new parent, you’re probably adjusting to the lack of sleep and your new responsibilities.

If you’re already a parent with older children in the house, life suddenly got busy and it’s an accomplishment getting all your littles fed, changed, napped and maybe even out of the house.

With all this noise, sometimes the last thing on your mind is the shape and position of your baby’s head. This is why small head shape changes can sometimes go unnoticed until they are suddenly worse.

Changes to a baby’s head shape can happen very quickly, typically in the first few months of their life. They can occur as early as 6-8 weeks old before infants are able to move their heads on their own and when they are positioned for prolonged periods of time on their backs on hard or flat surfaces – think bassinettes, cribs, car seats, strollers, swings, bouncy seats and carriers.

If their head is constantly in the same direction, so is the pressure on their soft, mouldable skull creating a flat spot in one of the following ways.


  • Prefers to Look to One Side
  • Flat Spot on the Back of the Head on One Side
  • Ear Shifted Forward on the Same Side of the Flat Spot
  • Forehead More Prominent on the Same Side of the Flat Spot
  • One Eye May Appear Smaller Than the Other
  • One Cheek May Appear Fuller Than the Other
  • Jawline Asymmetry


  • Prefers to Look Up
  • Flat Spot on the Back of the Head in the Middle
  • Head Can Look Taller at the Back
  • Head Can Look Wider at the Sides
  • Fullness Above the Ears


  • Multiples
  • First Born
  • Intrauterine Constraint
  • Torticollis
  • Premature Birth
  • Assisted Delivery
  • Positional Preference
  • Lack of Tummy Time
  • Motor milestone delays


Sometimes no matter how many times you reposition your baby’s head off the flat spot, the strong preference to look in the same direction persists. If this is the case, there may be underlying tension in their neck muscles known as Congenital Muscular Torticollis (CMT) predisposing them to look in the same direction.

Torticollis is a tightening of the Sternocleidomastoid (SCM) muscle on one side. This muscle SIDE BENDS the head to the SAME side as the tight muscle and ROTATES the head to the OPPOSITE side of that same muscle. Very rarely there could also be a lump or mass in the SCM.


Head shape can be improved. Early treatment is key for the most optimal results – the younger the baby, the more likely you are to impact head shape favourably. You will also save time, effort and interventions later on.

If you’ve said one of the following:
~ “My baby and I struggle with feeding”
~ ”My baby only looks one way”
~ “My baby’s head is tilted to one side”
~ “My baby has a flat spot on the back of their head”

Follow your intuition. See your physician. Get a physical therapy assessment. Not all cases resolve on their own. It is easily addressed with conservative management when caught early. A pediatric physiotherapist will show you stretches, strengthening exercises, ways to carry your baby and repositioning strategies specific to your baby’s needs that can be incorporated into your daily routines.

It is important to note that babies should always be put to sleep on their backs for safety. Recommended treatments centre around their awake times.

Flat spots are a cosmetic concern, they have no impact on your baby’s brain development. But for some families, it can be a social concern wondering if it will be noticeable with short haircuts. In more significant cases, the asymmetry could make the proper fit of glasses or sports helmets challenging, but not impossible.

Depending on the severity and the age of the baby, a referral may be made for moderate and severe cases for further consultation regarding the need for helmet therapy. You will be able to discuss with your physiotherapist whether this is recommended after your assessment.

Joanna Smith PT Country Hills Physio Calgary NW

Joanna Smith


Joanna graduated from the University of Alberta in 2004 with a Bachelor of Science in Physical Therapy. Prior to this she pursued a Kinesiology degree at the University of Calgary. A lifelong learner, continuing education courses have fuelled Joanna’s passion for her profession. She has completed post-graduate courses in manual therapy, Anatomical Acupuncture, GunnIMS, pain…


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